Exam 2 Flashcards
R brain (L hemi) behavioral differences
Unilateral neglect L visual field Impulsive, poor judgment Overestimate abilities, unaware of impairments
Autonomic, behavior arrest, cognitive, emotional
Focal non-motor
Dementia: What are the different %’s
70% Alzheimer’s type 20% vascular (ischemic stroke: memory, cognition, social function)
Weber test
-Sound lateralization/localization -Tuning fork on middle of head
Cardinal features of PD
Rigidity, bradykinesia, resting tremor, postural instability (Trunk flexors > extensors), shuffle gait, festinating gait
Severity and duration of comas represented by:
Glasgow coma scale: 3-8: Severe head injury; coma 9-12: Moderate head injury; 9-10=coming out of coma 13-15: Mild head injury
PT management peripheral vestibular dysfunction
- BPPV: Positional treatment
- UVH/BVH: Gaze stability, gait, balance, habituation
L brain (R hemi) behavioral differences
Difficult communications (Aphasia) Negative, anxious, slow, careful Aware of impairments
Most common subtype of GBS:
AIDP
Divergence
Simultaneous outward movement of both eyes
CN IX and X
-Glossopharyngeal, Vagus -Gag reflex, swallow, taste
Strabismus
-Eye misalignment -Lack of coordination between extraocular muscles -Exotropia, Esotropia, Amblyopia
Injuries that cause cortical visual impairment
Stroke, TBI, seizure, hydrocephalus
Saccule
Vertical acceleration
Classifications of head trauma
-Primary: skull fx; gray matter contusion, diffuse white matter dmg -Secondary: Anoxia; swelling/ICP hematoma -Open: penetration, dura compromised -Closed: non-penetration; dura uncompromised
Describe the development of the nervous system in infants and children:
All neurons present, but not all connections are made Nervous system sensitive to insults
Consensual reflex
constrict in response to light in other eye
Presbyopia
-Farsighted -Not a corneal problem -Lens can’t focus -Lost lens elasticity -Bifocal lenses
Metastatic brain tumors:
Primary: Brain–>elsewhere Secondary: Elsewhere–>brain
What is the frontal lobe of the Cerebrum for?
Motor cortex: speech, Broca’s, decision making, problem solving, concentration, short-term memory, self-awareness, goal-orientation and drive, emotions and affect
Aspects of mental status:
- Level of consciousness: aware, orientx3, cooperative 2. Confusion: Inappropriate response, decreased attention 3. Lethargy: Drowsy, gives appropriate responses when aroused 4. Stupor: 1 step before coma, arousal for short period and slowed motor 5. Coma: Decorticate (UE flex, LE ext), Decerebrate (UE ext/IR, PF) 6. Delirium: TBI, withdrawal, confusion, anxiety, impaired memory/attention, illusions
Eye conditions associated with CP
Strabismus
Signs cortical visual impairment
-Color preference, vision loss, delay to visual stimuli, difficulty visualizing new surroundings, view close objects at close range and odd angles
Cortical visual impairment
-Decreased visual response d/t neurological problem affecting occipital cortex
Eye conditions associated with Hydrocephalus
- Double vision, reduced vision, strabismus, amblyopia
- Sunsetting sign: shunt
- Increase CSF puts pressure on optic nerve
What types of body dysfunctions will be seen in Guillian-Berre syndrome?
Motor, sensory, autonomic
Describe the development of neurological systems in older adults:
-No change in cognitive function <60 unless pathology -Decreases in problem solving, short term memory, information process/new concepts -Verbal, inventories, long term memory in-tact
Medical treatment of Myasthenia gravis:
AChE inhibitor, thymus removal, immunosuppressant, plasmapheresis
Cognitive and behavioral changes after TBI measured by:
Ranchos Los amigos
Medical treatment for post-polio
Treatment and lifestyle modification, surgery/tendon transfer
Clinical features peripheral vestibular dysfunction
Normal smooth pursuit and saccades, positions bring nystagmus, hearing loss, mild ataxia, intense vertigo suppressed by visual fixation, slow and fast nystagmus, N/V
what is the parietal lobe of Cerebrum for?
Receive and process information
Rinne’s test
- Tuning fork on mastoid
- Tuning fork by ear
- Ear time should be 2x longer than mastoid time
Peripheral vestibular dysfunction mechanisms
Mechanical
Decreased receptor input
CN XII
- Hypoglossal
- Tongue movement and strength
- Tongue deviates toward weak side
Clinical features of Myasthenia gravis
Ptosis of eyelids, double vision, difficulty holding head upright, difficulty chewing meat or swallowing
Proximal weakness > distal
Meniere’s disease
- Inner ear disorder
- Too much fluid
- Vertigo, tinnitus, hearing loss
- Low Na, avoid caffeine/alcohol, diuretics
S/S MS:
Paresthesias, paresis, paralysis, spastic, fatigue, worsening vision, dysarthria, depression, bowel/bladder, sexual dysfunction
Retinal detachment
- Retina pulls away
- Floaters, flashes of light, curtain
- Air or gas injection
PERRLA
Pupils equal
Round
Reactive to Light
responsive to Accommodation
Pupillary reflex
constrict in response to light
Retinoblastoma
- Cancerous tumor of retina
- Child <6
- White pupil
Eye conditions associated with Fetal alcohol syndrome
-Refractive errors and strabismus
What to do during autonomic dysreflexia:
Sit pt up, check catheter or other irritants, get help if doesn’t subside
Medical treatment of GBS:
IVIg, plasmapheresis
Treatment of Retinoblastoma
- Laser therapy 1st
- Chemo and radiation after
Mechanical peripheral vestibular dysfunction
- BPPV: Otoconia misplaced
- Canalithiasis: otoconia float free
- Cupololithiasis: Otoconia adhere
Features of post-polio
Decreased strength, myalgia, jt pain, increased atrophy and fatigue
Modified Ashworth Scale
0: No increase
1: Catch and release
1+: catch with min resistance through rest
2: Increase through ROM but easily moved
3: Passive movement difficult
4: Rigid flexion or extension
Automatisms, atonic, clonic, spasms, hyperkinetic
Focal motor
Physical Therapy and Myasthenia gravis:
Energy conservation techniques, isometric strength training, frequent rest
Pathology of PD
Substantia nigra stops making dopamine
Diagnosis of MS
History, clinical findings, MRI (>2 lesions), CSF (elevated immunoglob), evoked potentials
Common TBI caused throughout the ages
0-4: shaken baby; falls
15-24: MVA
65+: falls
Post-polio
NM symptoms after polio, muscle fibers too stressed and retract, often will only be seen in >65 yoa
Utricle
Horizontal acceleration
CN I
- Olfactory
- Smell
- test each nostril separately
Vestibulo-ocular reflex (VOR)
- Stabilize images in center of visual field
- Eye movement opposite head movement
Most common SCIs:
C5-C7; T12-L2
Otoliths
Linear acceleration and gravity
Subtypes of GBS:
AIDP, AMAN, ASAN, CIDP, Miller fisher (ataxia)
Broca’s area location
Wernicke’s area location
Broca’s: frontal lobe
Wernicke’s: temporal lobe
Most common form of PD:
Parkinsonism affecting BG
CN V
- Trigeminal
- Face sensation: cotton ball
- Clench teeth: palpate masseter
- Corneal: cotton ball to eye
Etiology of central vestibular dysfunction
UMN, stroke, TIA, MS, trauma
Clinical findings of SCI
S/M impairment, spastic, orthostatic HTN, autonomic dysfunction (C3 and above require respirator), bowel/bladder/sex dysfunction
Rinne’s test meaning
- Normal: air conduction 2x bone
- Conductive: Bone conduction longer or equal
- Sensorineural: air conduction longer but not 2x
S/S brain tumors:
Seizures, focal weakness, cognitive changes, behavioral changes
Interrupts sleep or worse upon wakening, elicited by postural changes, cough, sneeze, different than previous headache
Limb weakness in Guillian-Berre syndrome vs Myasthenia Gravis
Guillian-Berre syndrome: Distal weakness > proximal
Myasthenia gravis: Proximal weakness > distal
Goals for brain tumors
QOL; allow for changes in pt status
Saccades
Quick, simultaneous movements of both eyes in same direction
Anxiety:
Most common psychiatric disease
Anxiety/fear interacting with personal social and occupation function
Sweating, dizzy, restless fatigue
Clinical features central vestibular dysfunction
Abnormal smooth pursuit or saccadic eye movements, diplopia, altered conscious, severe ataxia, slight vertigo not suppressed by visual fixation, vertical nystagmus, oscillate at equal speeds
Guillian-Berre Syndrome
Autoimmune disease of acute inflammatory demyelination polyneuropathy that attacks myelin
What direction does endolymph move
Opposite direction of head movements
What are the different seizure disorders?
- Mechanical: birth injury, head trauma, tumor, stroke
- Metabolic: Electrolyte, glucose, metabolism error
- Genetic: familial neonatal seizures, juvenile myoclonic epilepsy
- Other: fever, infection
Course of GBS:
Onset–>peak: 4 wks
Recovery: 2 yrs
Ambulation: ~6 mos
what is the temporal lobe of cerebrum for?
Perception and interpretation of sounds, comprehension (wernickes), integration behavior, emotion, personality, long-term memory
Myopia
- Nearsighted
- Cornea excessively curved or eye is too long
- light in front of retina
Autonomic dysreflexia
Pathological lesion if above T6;
Results in Increased BP and no vasodilation, bradycardia, severe pounding headache, Increased spasticity
Describe the development of neurological systems in infants and children:
- All neurons present but not all connections are made
- Nerves are sensitive to insults
Vestibulospinal reflex
Control of postural muscles to stabilize body/head in upright position
Sudden, excess, abnormal electrical discharge of aggregates of neurons in brain
Seizures
Describe the development of the nervous system in older adults:
- No change in cognitive function <60 unless pathology
- Decrease in problem solving, short-term memory, information processing and new concepts
- In-tact verbal, inventories, and long term memory
4 types of MS:
- Relapse remit: Best prognosis
- Secondary progressive
- Primary progressive: Poor prognosis
- Progressive relapse
Weber test meaning
- Normal: equal in both ears
- Conductive: Sound more toward poor ear
- Sensorineural: sound more toward good ear
Eye conditions associated with Down Syndrome
- Refractive errors
- Strabismus
- Presbyopia
- Nystagmus
- Cataracts
Nystagmus
- Involuntary eye movement part of VOR
- Smooth pursuit in 1 direction
- Saccadic movement in other direction
Convergence
Simultaneous inward movement of both eyes
Schizophrenia:
Onset: early adolescence, early adulthood
Severe persistent, psychotic syndromes resulting in detaching from reality
S/S: hallucinations, paranoid, inappropriate affect
Describe the development of the nervous system in adolescents:
Continued intellectual maturation, develop abstract thinking, judgment, and values
Semicircular canal
Angular acceleration
Retinopathy of prematurity
- Infants <3lb5oz
- Retina BVs grow in abnormal fashion causing damage
- Spontaneous resolvement
What is the brainstem involved with?
reticular activation system, consciousness
Glaucoma
- High pressure damage optic nerve
- Tunnel vision
-Medication, laser therapy, surgery
Where are lesions found in Guillian-Berre Syndrome
PNS from Spinal n roots to distal motor and sensory
Hyperopia
- Farsighted
- Insufficient curvature or eye is too short
- light behind retina
Changes to the brain d/t Alzheimers disease:
Plaques: collection of protein outside the brain
Tangles: Protein twists in abnormal twists in brain
3 sensory systems that contribute to balance?
Vestibular, vision, somatosensory/proprioception
Decreased receptor input peripheral vestibular dysfunction
UVH BVH: habituation
Age related conditions
Cataracts, macular degeneration, glaucoma, diabetic retinopathy, retinal detachment
PT and GBS
Prevent complications from immobilization, don’t overfatigue, maintain ROM, monitor strength, skin, educate, orthotics
Why do we assess mental health?
Design best POC, safety, writing goals, referring, communication style
Describe the development of neurological systems in adolescents:
- Continued intellectual maturation
- Abstract thinking
- Judgment d/t education, intelligence, experience
- Values
PT and post-polio
- General conditioning, don’t fatigue
- Energy conservation techniques, orthotics
Recurrent seizures caused by genetics, TBI, stroke, brain tumor, CP, infectious diseases, or unknown
Epilepsy
PT management for Central vestibular dysfunction
- Educate on safety and fall prevention
- Gait training, balance, habituation
Clinical features of GBS:
Ascend symmetrical: Motor and sensory impairments and autonomic symptoms, proximal weakness > distal, LE before UE, CN’s, No DTRs, Paresthesias, BP. HR, fatigue
Macular degeneration
- Tissue for center of visual field deteriorates
- Medication, laser therapy, surgery
- Dry
- Wet: fluid/blood into macula
CN VIII
- Vestibulococchlear
- Rinne’s
- Weber
Most common primary brain tumor
Glioma Glioblastoma: poor prognosis
CN II
- Optic
- Visual acuity
- Snellen wall chart (20/20)
- test each eye separate
Accomodation/convergence reflex
Pupil should constrict when finger is brought to nose
CN III, IV, VI
- Oculomotor, Trochlear, Abducens
- CN VI: Lateral rectus AB
- CN IV: Superior oblque down/in
- CN III: rest of eye muscles
Classification of seizures:
Focal (1 side)–>aware or non-aware–>motor or non-motor Generalized (diff. segments)–>motor or non-motor Unknown–>Motor or non-motor
What we assess for mental status in patients
History, physical appearance/behavior, cognitive function, speech/language, emotional stability
Chronic autoimmune inflammatory demyelination of CNS white matter; severing axons causing conduction block and LOF
MS
Mania:
Elevated/euphoric or irritable/agitated mood >1wk Hyper, over confident, exaggerated self image, decreased need for sleep, poor social judgment
Astigmatism
-Asymmetrical eye -Multiple focal points -Near and far blurry
Cataracts
-Clouding of lens, blurry, night blind, fading/yellow colors -Surgery
How to determine neurological levels for Sensory and Motor
Sensory: last normal dermatome Motor: Last normal myotome w/ 3/5
Amblyopia
-Lazy eye -Decrease vision in 1 eye -Brain favors strong eye
CN VII
-Facial -Wrinkle forehead -Close eyes -Show teeth -Puff cheeks
Myasthenia gravis:
Autoimmune motor end plate disease causing decreased AcH receptors; reduced efficiency of neuromuscular transmission and easily fatigue able muscle activity
CN XI
-Accessory -Upper trap and SCM strength -shrug shoulders and turn head
Types of hematoma
-Acute epidural: tear meningeal artery between skull and dura mater; fast bleed -Acute subdural: Venous rupture between dura and arachnoid; long bleed over time
Screening for depression:
-PHQ2: Yes to 2; refer out -Geriatric: >5/10=depression
What is the limbic system involved with?
mediate behavior for survival (mating, fear, aggression, affection)
